Article

The benign occipital epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine.

Department of Neurology, McGill University, Montreal Neurological Hospital and Institute, Quebec, Canada.
Epilepsia (Impact Factor: 4.58). 02/1998; 39 Suppl 4:S9-23.
Source: PubMed

ABSTRACT Benign occipital epilepsy of childhood is an idiopathic partial epilepsy syndrome with elementary visual symptomatology, frequently associated with other ictal phenomena. Seizures are usually followed by postictal headache and are often associated with interictal occipital rhythmic paroxysmal EEG activity that appears only after eye closure. In some children the ictal visual symptoms or the interictal EEG abnormalities may not be demonstrated. The clinical and/or EEG manifestations of other forms of idiopathic partial or generalized epilepsy may be found in association. Occipital spikes in non-epileptic children with defective vision, occipital slow spike-and-wave found in some patients with the Lennox-Gastaut syndrome, focal epilepsy due to occipital lesions, seizures originating in the temporal lobe secondary to an occipital abnormality, and complicated or basilar migraine must be considered in the differential diagnosis. Early-onset benign occipital epilepsy or seizure susceptibility syndrome deserves to be considered separately. It has been defined by Panayiotopoulos as consisting of brief, infrequent attacks or prolonged status epilepticus and characterized by ictal deviation of the eyes and/or head and vomiting, occurring in children usually between the ages of 3 and 7 years. Advances in molecular genetics will help decide whether these two disorders are indeed distinct. Benign occipital and benign rolandic epilepsy are commonly associated with migraine. The selective involvement of the occipital lobe in migraine has not been fully explained. The association between benign occipital epilepsy and migraine is likely related to this underlying mechanism as well. The "fixation off" phenomenon or blocking of occipital epileptic discharges by eye opening is not specific to benign occipital epilepsy of childhood and may be found in symptomatic epilepsies as well. Migraine and epilepsy are distinct disorders, both as far as their pathophysiologic mechanisms and clinical symptomatology are concerned. There is however an overlap in some patients and a causal relationship may exist in some, leading to clinically distinct migraine epilepsy syndromes. Here too, clarification of the molecular basis of migraine and of epilepsy will throw light on the nature of the relationship between the two conditions.

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    ABSTRACT: OBJETIVO: Estudiar la evolución del grafoelemento EEG característico de la epilepsia occipital benigna infantil y la influencia que sobre ésta tiene la edad, el sexo, el curso de la epilepsia y su tratamiento. MÉTODOS: Estudio longitudinal retrospectivo de una serie de 30 pacientes diagnosticados de epilepsia parcial benigna occipital según criterios de la ILAE. Analizamos la secuencia temporal de aparición, migración y desaparición del foco EEG mediante el coeficiente de correlación de Pearson y pruebas no paramétricas. RESULTADOS: El primer paroxismo occipital aparece precozmente cuando los vómitos forman parte de las crisis (p < 0,01) y cuando éstas son prolongadas (p = 0,05). Su aparición es más tardía cuando hay antecedente de crisis febriles o aura visual (p < 0,05). Los vómitos críticos se asocian a una duración mayor de la punta occipital a lo largo de los años (p < 0,05). La migración anterior del foco EEG ocurre en las epilepsias de inicio precoz y predice una remisión tardía de las crisis (p < 0,05). Otros paroxismos asociados a los occipitales aparecen sobre todo en los casos con mayor duración de las crisis y de la punta occipital. CONCLUSIONES: La punta occipital permanece más en el tiempo que las crisis. La presencia de vómitos es el único síntoma que se relaciona con características electroencefalográficas concretas: aparición temprana del grafoelemento occipital, mayor duración del mismo y edad de finalización más tardía. Benign childhood occipital epilepsy: evolution of the occipital spikes PURPOSE: We studied the electro-clinical evolution of the occipital EEG discharges characteristic of partial benign epilepsy of childhood with occipital paroxysms. The influence of age, sex, epilepsy course and treatment on the evolution of this electrical event were analyzed. METHODS: A longitudinal retrospective study that included 30 patients who fullfilled the diagnostic criteria of benign occipital epilepsy proposed by the ILAE. The onset, migration and disappearance of EEG foci were analyzed using the Pearson coeficient and non-parametric tests. RESULTS: Occipital spikes are found earlier when vomiting is an ictal symptom (p < 0.01) or longer seizures (p = 0.05). Patients with and antecedent of febrile seizures or with an visual aura show a later onset of occipital spikes (p < 0.05). Ictal vomiting is associated with a longer persistence of occipital spikes along the years. Migration of EEG foci to anterior regions is characteristic of early onset seizures and predicts a later remission (p < 0.05). Extraoccipital foci are associated with a high seizure and occipital spike recurrence rate. CONCLUSIONS: Occipital spikes persist longer than seizures. Ictal vomiting is the only symptom related to specific EEG features: early onset, longer evolution and late remission of EEG discharges.
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